The sturdiest oak in American surgery has fallen; we have lost our trustiest compass. When my wife and I were first told that Dr. Francis Moore had died, we comforted each other through tears.

It was in the summer of 1943, during World War II, that I first met Franny. He was Chief Surgical Resident at Massachusetts General Hospital and I was a fourth year medical student assigned to his service. His crisp mind, articulate speech, and surgical skills were astounding. Equally impressive was his sensitivity when dealing with patients, nurses, and operating room staff. His teaching sparkled. He set the highest surgical standards for my entire professional life.

His talents were recognized early. Two years after medical school, during his junior residency, he obtained a fellowship from the National Research Council to study the use of radioactive isotopes in research, a new field of inquiry. Thus began his lifelong interest in the chemical anatomy of the body, otherwise known as body composition. His book, Metabolic Care of the Surgical Patient, published in 1959, fully documents the completion of this research and serves as a unique resource in burn centers and recovery rooms worldwide.

Franny’s body composition study is not only applicable to surgical patients; it also documents fundamental truths of physiology and biochemistry. Using tiny doses of both radioactive and stable isotopes in patients with heart failure, starvation, infection, and in seriously overweight patients, he literally brought science to the bedside in the Brigham and Women’s specially designed Bartlett Unit, named for his wife’s family.

His moral character and sense of decency were also apparent early in his career. During World War II, when residency training was accelerated, thus giving younger and younger surgeons more responsibility, Franny, as Chief Resident, emphasized professional conduct, ethics, and honesty—along with the need for surgical skill.

I was overjoyed to learn in 1947, while still on active duty at Valley Forge Army Hospital, that Franny had been appointed the new Moseley Professor and Surgeon-in-Chief at Brigham and Women’s Hospital. After my Army discharge and return to the Brigham, it was my good fortune to be assigned as his Assistant Resident on the first day of his tenure there, July 1, 1948.

With his new laboratory and library set up adjacent to his private office, he vastly expanded the traditional pattern of a Chief of Surgery. His vision advanced the discipline of surgery beyond surgical technique. He incorporated physics, physiology, biochemistry, and metabolism into surgical thinking and writing. Endocrinology and nutrition became components of surgery as necessary as knowledge of anatomy, pathology, suture materials, and knot-tying. He himself was a superb technical surgeon, equal to any surgeon whose reputation was based on operating room brilliance.

After completing his residency, he remained ambivalent about his career. As he put it, he was “part surgical practitioner, part surgical scientist… never wishing to abandon completely the job of surgery despite the pull of the laboratory.”

He exemplified rigorous, invincible honesty to his several hundred trainees. His weekly “mortality and morbidity” conferences encouraged open discussion of errors in diagnosis, complications, and unanticipated intra-operative difficulties. When he was critical of any of our actions, he was gentle but firm.

He once defined surgery as “organized optimism” and research as “organized play for grownups.” We mere mortals may not have always agreed with his definition of play, which he described as “any activity that requires skill, attention to detail, enjoying the struggle, getting the right team, planning to win, and exhaustive exertion in a single minded purpose.”

When Franny came to the Brigham in 1948, Dr. George W. Thorn, Physician-in-Chief, had already started a renal transplant program. Franny, recognizing its importance, urged members of his staff to participate in the study of transplantation biology. He unselfishly supported and encouraged me from day one. He pioneered liver transplantation in both the lab and in man. He was a key player in establishing the New England Organ Bank and the Definition of Death Based on Irreversible Loss of Brain Function.

It is impossible to characterize Francis D. Moore fully. He was electric. He lit up everyone he contacted: musicians, lawyers, writers, physicians, and surgeons. Without being overbearing, his restless curiosity enlivened all. As one U.K. Research Fellow commented some 40 years ago, “Enter Franny’s office discouraged, leave cheerful.”

Possibly Franny as a person is best described by four words he himself used to describe the Brigham as a hospital, “Mercy, wisdom, science, and humanism.”

Dr. Joseph E. Murray

Boston, Massachusetts

My surgical experience as a child was confined to appendicitis at age 12 and a fractured knee at 14. After the appendix operation, my rowdy friends came to call, and we got to laughing. It hurt. Surgery. As for the knee, maybe that carried some sort of an academic message, because Frederick Christopher, a surgeon of Winnetka, thought my fractured knee was unusual (as I was certain, of course, that it was). It was depicted in his Textbook of Minor Surgery. Impressive. I still have the volume as a memorial to my adolescent trauma.

In 1933 as a sophomore in college, I decided to apply for admission to medical school. As a third-year medical student in 1937 I resolved to try for a surgical internship and started out as a fledgling surgeon on July 1, 1939. Just halfway between those two decisions, in June 1935, Laura Bartlett and I were married.

My decisions to enter medicine as a profession and the field of surgery as a calling had at least some basis in my childhood experiences. Although there were no physicians on either side of my family as far back as we could trace, I enjoyed science and especially biological science. As a child I had the privilege of being the patient of several remarkable doctors, two of them surgeons. Surgery was probably the inevitable choice, as I enjoyed a certain degree of manual dexterity, whether it be playing the piano or tinkering in the tool shop. Being by nature more a participant than an observer, I favored the interventionist mode as an approach to

human illness. With regard to the decision for marriage, Laurie and I had attended school together. As college graduation approached, our mutual chemistry of attraction naturally led to marriage. In those days that was the only acceptable way to consummate our desire.

This is the story of a privileged childhood, of wonderful years at school and college, of working as a surgeon for more than half of this century, and of living with a remarkable family for four-fifths of it. For me as a surgeon in a university and its teaching hospitals, and later as professor and department head, teaching and research have always been a prominent part of my life. During these years there has been a massive increase in the scope and effectiveness of biomedical science and of surgery. Our research played a role in that growth. The central theme of this book is surgery in an era of change.

Now entering my ninth decade and approaching the end of both this century and this life, I look back on a satisfying career and a spate of extraordinary happenings. I have enjoyed writing these stories, both of my own experiences and of a revolution in the science of human biology and the art of surgery. For many readers born before 1950, these matters may have a familiar timbre. For others—especially those of a younger generation—these tales may be mere bits of ancient life, or history retold.

This account would be incomplete without telling of individual patients, whose stories are strong threads woven into the fabric of a surgeon’s life. Many of these stories are of patients (often under fictitious names) who lived despite severe challenge. A surgeon sees much of life. Wonderful, joyous, human life. And hopes to ensure a few more good years for many people.

There are also stories here of death. A surgeon caring for the seriously ill or injured, for cancer, sees much of death. A man who lost his wife after 53 years of wonderful marriage cannot help but consider the meaning of death. And now, there is an urgent need to ease the end along for some who are facing painful and hopeless illness.

All these tales are of medical, surgical, and scientific friends, leaders, stars; and of the family that decorated my life.

F.D.M.

Boston, Massachusetts

April, 1995

I am deeply indebted to friends and family who have stuck with me faithfully through the conception and gestation of this book. Laurie went over some of the earlier stories with me, and Katharyn has been over the whole book in its later stages, offering much helpful advice.

Four faithful readers have helped mold and organize the book in detail. I am grateful to Fisher Howe III, former Foreign Service Officer, currently consultant on funding for nonprofit organizations; Henry Saltonstall, surgeon of Exeter, New Hampshire; Leroy D. Vandam, Professor Emeritus of Anaesthesia at Harvard, our staff anesthetist for 26 years; and Charles F. Haas, classmate and Hollywood author-producer. All are familiar with many of the happenings, stories, and people of this book.

I am also indebted to colleagues at the Brigham, Harvard, and other institutions who have made contributions and detailed suggestions. These include Marcia Angell, Clyde Barker, Robert Bartlett, Saul Benison, Donald Brief, E. Langdon Burwell, Sir Roy Calne, Andrea Chambers, John Collins, James Dalen, Robert Demling, Lewis Dexter, Ben Eiseman, Dwight Harken, John Howard, Richard Lower, John Mannick, Robert Mayer, Anthony Monaco, Joseph Murray, John Najarian, Israel Penn, Lucie Prinz, Steven Rosenberg, Jay Sanford, Richard Shemin, Thomas Starzl, Judith Swazey, Richard Warren, Douglas Wilmore, and Lawrence Zaroff. Richard Wolfe, Curator of Rare Books and Manuscripts at the

Countway Library, opened his collection generously for reference and illustrations. John Dusseau, formerly editor at WB Saunders, who assisted with two of my previous books, has generously given advice on this one.

For retrieval of archival pictures from the medical school and the hospital, I am indebted to Madeleine Mullin and Susan Berg; for photographic reproduction of slides and illustrations, to Ken Bates; and for aerial photography of the hospital and the medical school, to Joseph Melanson of Wareham, Massachusetts.

Scott Lubeck, Director, and Stephen Mautner, Executive Editor, and their staff at the Joseph Henry Press have been responsive and helpful throughout the production of a finished book from the original manuscript.

Dr. Oglesby Paul, author of several medical biographies, gave me experienced help. To Diane Q. Forti, medical editor extraordinaire, I am indebted for her detailed suggestions throughout the book. Susan Lang Cramer contributed her skills abundantly as both editor and typist through the long period of preparation and revision of this manuscript. To all, I am most grateful.